Healthcare Provider Details

I. General information

NPI: 1871909499
Provider Name (Legal Business Name): MRS. DIANA LAZARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 55TH ST
BROOKLYN NY
11219-4202
US

IV. Provider business mailing address

400 ARGYLE RD APT. RB4
BROOKLYN NY
11218-5459
US

V. Phone/Fax

Practice location:
  • Phone: 646-261-8213
  • Fax:
Mailing address:
  • Phone: 646-261-8213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number843405141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: